Colorado Medicaid and CHP+ Provider Revalidation & Enrollment Has Begun
New federal regulations by the Centers for Medicare & Medicaid Services (CMS) require that all Medicare, Medicaid and CHP+ providers undergo enhanced screening and revalidation.
Revalidation Frequently Asked Questions
Please note – the information provided below is a summary to provide you with basic information. For more detailed information, please visit the Department of Health Care Policy and Financing’s Provider Resources webpage here.
- 1. What is the purpose of this initiative? The Centers for Medicare and Medicaid Services (CMS) now requires enhanced screening (through the enrollment process) and revalidation of all providers (Medicare, Medicaid, Child Health Plan Plus, and State Managed Care Network). All Colorado providers who want to provide services to Medicaid and CHP+ patients by March 1, 2017, are required to enroll and/or revalidate their licensure and business information under this new federal enrollment screening criteria. It can take up to 30 days to get the application going. Applications are processed far more quickly when providers review the published enrollment guidelines, take the online enrollment trainings, and collect necessary documentation before beginning the application process. The Department of Health Care Policy and Financing (HCPF) has posted more information on the provider screening rule on their website; click here.
- 2. What’s the difference between revalidation and enrollment process with the State?
- Revalidation and enrollment are essentially the same thing. However, revalidation is what you need to complete if you have already been enrolled and validated with the State as a Medicaid provider. Providers who have never enrolled before will need to go through the enrollment process, which includes becoming validated as a provider.
- 3. Is enrollment/revalidation required if not participating with Fee for Service Medicaid? Yes, revalidation is required for all providers including those participating in Medicaid, Child Health Plan Plus, and State Managed Care Network contracts.
- 4. Is revalidation required for the group and individual providers? Yes to both. Each individual provider needs to go through the revalidation process (or enrollment process, if the provider was never validated). Groups also need to go through the enrollment or revalidation process. Group applications should be submitted prior to individuals within the group but approval of the group application is not required before submitting the individual applications.
- 5. What if I can’t afford the cost for enrollment or revalidation? Generally, the cost to enroll or revalidate is the same for everyone. If you feel you have a special circumstance that might exempt you from this, please visit the Department of Health Care Policy’s frequently asked questions page here, and read information under the Application Fees and Exemptions heading.
- 6. I’m doing my revalidation for Medicaid and have to answer a question if I have a contract with any BHO or MCO, what does that mean? A BHO is a behavioral health organization. An MCO is a managed care organization. Colorado Access is known as both a BHO and an MCO. Access Behavioral Care is known as a BHO, while Child Health Plan Plus offered by Colorado Access is known as an MCO.
- 8. Will completing the revalidation process automatically enroll me as a Medicaid participating provider? If you are an existing Colorado Fee for Service Medicaid provider, revalidation doesn’t change your Medicaid participation status. If you are only a CHP+ or State Managed Care Network provider, you can complete the enrollment/revalidation process and continue to NOT accept Fee for Service Medicaid.
- 9. Will claims be denied if the provider has not completed the enrollment or revalidation process? In accordance with the Department of Health Care Policy and Financing, if a provider is not enrolled or revalidated before March 1, 2017, reimbursement for any services rendered to CHP+ and/or Medicaid members may be denied. Please note, the enrollment and revalidation process can take time to complete, so providers are encouraged to begin the process as soon as possible.
- 10. If a claim is denied because the provider is not enrolled as a Medicaid provider or has not gone through the revalidation process, can the member be billed for the services? State statute prohibits providers (Medicaid or non-Medicaid) from billing Medicaid and CHP+ members for covered services. Providers who do this may be reported to HCPF’s Program Integrity Unit. Providers who fail to revalidate are potentially putting their Medicaid reimbursement at risk as of March 1, 2017.
- 12. Who can I contact if I have any questions about the enrollment or revalidation application?
- 13. How will patients be affected?
- Patients cannot be billed for services given by a provider that is not validated. Providers may decide not to see members if they are not validated because they may not be reimbursed for the services.
- 14. What happens if a Medicaid provider sees a member without having revalidated?
- Even though the revalidation deadline has been extended to March 1, 2017, all Colorado providers need to complete revalidation and/or enrollment as soon as possible. HCPF is launching its new enrollment and claims management system, the Colorado interChange, on March 1, 2017. At that time, claims and encounters submitted by providers who have not enrolled and/or revalidated will be denied.
- 15. What happens if I enroll or revalidate late? For example, if I complete the process in December, will HCPF retro the enrollment or revalidation back to 3/1/17 so that claims can be paid back to the compliance date? Enrollment and revalidations will not be backdated. Providers need to revalidate as quickly as possible to avoid any impact on claims starting on March 1, 2017.